CPT code 29581 is used for the application of a multilayer compression system. This refers to the use of two or more layers of bandages, applied from the base of the toes to just below the patella, covering the foot, ankle, and calf. Each layer contributes to increased gradient compression. (CPT code description: application of multi-layer compression system; leg (below knee), including ankle and foot).
A gauze roll bandage followed by an ACE bandage or a self-adherent bandage such as Coban can be considered multilayer compression. According to the CMS Surgical Dressings - Policy Article (A54563): "Moderate or high compression bandages, conforming bandages, self-adherent bandages, and padding bandages are covered when they are part of a multi-layer compression bandage system used in the treatment of a venous stasis ulcer that meets the requirements to be a qualified wound." The same CMS Article provides more information those types of bandages (HCPCS in parenthesis):
- LIGHT COMPRESSION BANDAGE (A6448, A6449, A6450): these codes describe ACE-type elastic bandages.
- MODERATE/HIGH COMPRESSION BANDAGE (A6451, A6452): these codes describe elastic bandages that produce moderate or high compression that is sustained typically for one week.
- SELF-ADHERENT BANDAGE (A6453, A6454, A6455)
- CONFORMING BANDAGE (A6442, A6443, A6444, A6445, A6446, A6447): these codes describe roll gauze-type bandages made either of cotton or of synthetic materials such as nylon, viscose, polyester, rayon, or polyamide. These bandages are stretchable, but do not contain elastic fibers. These codes include short-stretch bandages.
- PADDING BANDAGE (A6441)
However, the level of compression provided can vary depending on the bandage materials, thickness, and the technique of the staff applying it. As a result, the exact therapeutic level of compression is not always consistent or known.
There are numerous commercial multilayer compression systems (ranging from 2 to 4 layers) specifically designed to provide light compression (around 20 mmHg) or full compression (35-40 mmHg). These systems have been tested for consistency, and manufacturers provide detailed application instructions to help ensure uniformity in the compression delivered when applied by different clinicians. At a CMS reimbursement rate of $157.79 per application by a nurse, hospitals can most likely offset the cost of commercial multilayer compression systems.
Please refer to these additional resources about compression therapy available in WoundReference: